2571CENTRAL VENOUS PRESSURE课件.pptVIP

Turn the patient’s head to the side opposite the catheter insertion site. The physician removes the dressing and exposes the insertion site. If sutures are in place, he removes them carefully. Turn the I.V. solution off. The physician pulls the catheter out in a slow, smooth motion and then applies pressure to the insertion site. Clean the insertion site, apply povidone-iodine ointment, and cover it with a dressing as ordered. Assess the patient for signs of respiratory distress, which may indicate an air embolism. Special considerations As ordered, arrange for daily chest X-rays to check catheter placement. Care for the insertion site according to your facility’s policy. Typically, you’ll change the dressing every 24 to 48 hours. Be sure to wash your hands before performing dressing changes and to use aseptic technique and sterile gloves when re-dressing the site. When removing the old dressing, observe for signs of infection, such as redness, and note any patient complaints of tenderness. Apply ointment, and then cover the site with a sterile gauze dressing or a clear occlusive dressing. After the initial CVP reading, reevaluate readings frequently to establish a baseline for the patient. Authorities recommend obtaining readings at 15-, 30-, and 60-minute intervals to establish a baseline. If the patient’s CVP fluctuates by more than 2 cm H2O, suspect a change in his clinical status and report this finding to the physician Change the I.V. solution every 24 hours and the I.V. tubing every 48 hours, according to facility policy. Expect the physician to change the catheter every 72 hours. Label the I.V. solution, tubing, and dressing with the date, time, and your initials. Complications Complications of CVP monitoring include: pneumothorax (which typically occurs upon catheter insertion) sepsis thrombus vessel or adjacent organ puncture, and air embolism Documentation Document all dressing, tubing, and solution changes. Do